Few quick fixes for MNsure problems, Optum report finds

Optum’s “end-to-end” review of MNsure concludes that there are few quick fixes to many of the stubborn technical issues plaguing the exchange.

That finding will translate into continued problems for the exchange and for consumers.

The report from a subsidiary of UnitedHealth Group — released Wednesday — said that it would be difficult to fix many of the glitches before the end of March and that manual workarounds would have to continue.

“[W]e are able to conclude that, while MNsure will fall short of achieving its original enrollment goals and consumer satisfaction levels, continuous improvements can be made in both the short-term and long-term,” according to the review.

The review, conducted for free, reads a bit like a sales pitch for how Optum could fix the beleaguered exchange.

A MNsure spokesman confirmed the state would be looking for an outside firm to come in and rehab the marketplace. He clarified, however, that the state would bid the process out and that it’s not guaranteed to go to Optum.

The review highlights known issues with the exchange’s technology and call center, which include spotty service and wait times that hover around the hour mark.

It divides potential fixes into multiple segments: solutions that can be completed before 2014 open enrollment ends in March and preparations for the next periods in 2015 and 2016.

“The only option available to complete the 2014 enrollment period through [the first] quarter is to continue utilizing the existing system,” according to the review. “Some improvements can be implemented during this time. However, the majority of attention must be focused on interim actions and manual efforts required to meet enrollment targets.”

The review also notes that that a “large gap exists between required functionality and what has been delivered,” including key features for small businesses, navigators and brokers. It also noted that the development schedules “take precedence over quality” and called out inadequate testing of the marketplace.

Looking forward, Optum offered three scenarios to fix the exchange’s technology before consumers begin enrolling for 2015. Among those suggestions were to work within the existing technology, which could take up to two years to complete, or to start over.

“Existing Asset may need to be written off — sunk costs,” according to the report, which also mentioned the “possible introduction of new vendors.”

The state currently holds a roughly $45 million contract with four vendors to build the less-than-functional exchange. MNsure significantly decreased the role of its main vendor in February 2013 and took over leading the exchange build-out.

All of Optum’s solutions include spending more money and hiring more people to work on the exchange. But that could be tricky because enrollment projects show the exchange may lose money beginning in 2015.

If current enrollment stays on track for 2015, the exchange could have to cut $2.5 million from its budget, according to MNsure projections.

At a legislative hearing earlier this month, Board Chairman Brian Beutner said he didn’t want to come back to the state Legislature for additional funding.

I'm sure this falls outside the scope of Optum's review, but I cannot help but wonder how many of the problems with MNSure could have been avoided if implementation hadn't been delayed for two years by a hostile Legislature?

Senator Ted Cruz tried to delay it, calling for a one year delay in implementation due to these obvious problems and was labeled a kook and an extremist trying to block the will of the people, or something.

Sen. Cruz tried to delay implementation with the idea that after the 2014 elections he and his republican co-conspirators would be able to de-fund the Affordable Care Act and crush the hopes of tens of thousands of people to have access to affordable health care.

If Sen. Cruz had proposed to delay the implementation in order insure the technology and procedures were fully capable and working, he might have generated a lot of support but that was never, ever his goal.

Remember, Sen. Cruz represents Texas: the state with the highest percentage of citizens WITHOUT health care coverage and one of the states that has been most resistant to providing any care coverage to lower income folks, and refused to expand Medicaid even with full federal funding.

That was the case in the past, and it didn't work. Sure, if you had a (large) employer who provided good health benefits, all you had to deal with was the annual march of paying more for slightly less benefit.

But many with preexisting conditions couldn't get insurance. Those who could not afford insurance or thought they didn't need it could wind up bankrupt if medical disaster struck. Hospitals passed on the cost of uncompensated care to the rest of us.

Sure, we had (and still have) the best care in the world - Mayo, Cleveland Clinic, MD Anderson - but what good is a 5 star restaurant when you only have $20 to spend for dinner? We also had the biggest gap between cost of care and outcomes.

This whole fuss about healthcare.gov and MnSure is overblown. Sure, they screwed it up. We need to know how and why to avoid the next big screw up. MnSure's leadership deserves the criticism. But let's not forget that building the exchange was largely outsourced to private enterprise (as it should have been). But we tried to do too much in too little time.

But even with the screw up, MnSure worked for thousands. Not well, not cleanly, but did work. Personally, I was able to sign on, create an account, shop for plans, sign up, and pay. There were glitches in virtually every step and many opportunities to improve. But in the end it worked and in the first few days of January we received our new insurance cards.

So the failure of a system implementation does not negate the overall value of public policy. And a failed implementation does not invalidate the basic premise of an online exchange for health insurance. It just means we did it wrong.

That the TP GOP wanted to stop health care reform. It's not that hard for them to be obstructionist so they'll do just that when they can. The actual work on MNSure was handled badly mostly due to Private Industry and their hiring practices. Most of the people who do the work on the program are contract programmers. Contract employees are 'temp workers' who can be hired for short period contracts and laid off quickly without the company having to provide 'health benefits' (isn't that interesting? It's important to note.) for them. This has become the 'industry standard' in hiring practices. If there's a slow down on a project for any reason, including political reasons, the programmers would be let go and later, when and if the company restarts the project, they'll once again bring in contract 'temporary' programmers. The majority of the time they won't be the same contract programmers that previously worked on the program. This has become the industry standard for most of the private sector. These people will have to ramp up quickly and will have relearn what the previous contract group were attempting. Repeat this process a few time and it's understandable it ends up being a patchwork product. Add to that a political will to stop ACA and it only enhances the problems with a startup like MNSure.

Wow. I'm no Tea-Partiest, but I just have to shake my head to the think that the ink on the ACA isn't even dry and we're already seeing implementation failures of this magnitude at both the federal and state levels. Honestly, this isn't that complex of a web site, nor is it even high-trafficked by Internet standards, and the time and budget allotted to pull it off were extremely generous. I have to wonder if anyone even bothered to test it at all before rolling it out.

I get the need for affordable health care, I just have to wonder if the government is in over their heads.

The real problem is the explosive and virtually unchecked growth in health insurance costs. People want the world's best health care but when it comes time to pay they want somebody else to cover their costs. It just can't keep working that way. Even with Harris' examples, there is a lack of understanding of the true costs. People may get cheaper policies on MnSure but that doesn't mean that their care costs less. Someday people will get a true picture of what this new takeover of the system is going to cost in real terms and I'd be willing to bet many aren't going to like the pricetag.